Provider Demographics
NPI:1437303567
Name:ROCHELLE DENTAL
Entity type:Organization
Organization Name:ROCHELLE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-365-0056
Mailing Address - Street 1:615 SECOND AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:GA
Mailing Address - Zip Code:31079
Mailing Address - Country:US
Mailing Address - Phone:229-365-0056
Mailing Address - Fax:
Practice Address - Street 1:615 SECOND AVENUE
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:GA
Practice Address - Zip Code:31079
Practice Address - Country:US
Practice Address - Phone:229-365-0056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLONY DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty